AB0557 PERIPARTAL-ONSET OF LUPUS VASCULITIS WITH COMPLICATIONS OF ANTI-PHOSPHOLIPID SYNDROME-A CASE-BASED REVIEW
Authors: S. Onwualu Onosenigbuan, O. Ochiagha, O. Adelowo, H. Olaosebikan
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Lupus vasculitis (LV) <sup>[1]</sup> is one of the secondary vasculitides occurring in the setting of systemic lupus erythematosus most commonly affecting small vessels or medium vessels, rarely large vessels. LV is commonly associated with anti-phospholipid syndrome <sup>[2]</sup> <h3>Objectives</h3> <b>Case Report</b> 42year old female, 10weeks peripartal with twin-gestation presenting with progressive difficulty in walking with associated numbness and paraesthesia of the lower limbs <sup>[3]</sup>, difficulty in breathing, Fever, non-erosive polyarthralgia and polyarthritis. Her symptoms started after delivery of her set of twins after 10years of secondary infertility. On examination; generalised cutaneous vasculitic rashes, left foot drop, bilateral lower limb swelling, coarse crepitations at the lung bases, reduced power at both lower limbs2/5, reduced tone and reflexes. Reduced sensation to light and deep touch at the left foot. <h3>Methods</h3> To access practicable treatment modalities in resource poor settings-Nigeria. <h3>Results</h3> Electromyelography-Mononeuritis multiplex, HRCT-pulmonary embolism in bilateral pulmonary artery extending into the segmental artery, Doppler USS of both lower limbs-Acute deep vein thrombosis of the left internal jugular vein, ENA panel-positive dsDNA, anti-smith, anti-Ro/Anti-La, Antiphospholipid antibody panel <sup>[4]</sup>- Positive aCL, anti-B2GP1, LAC, thrombocytopenia, anaemia. Renal parameters marginally deranged. Elevated inflammatory markers. <b>Management</b> High dose corticosteroids, Rescue therapy low dose Rituximab @days 0,15 patient had minimal response, maintained on low dose prednisolone, azathioprine and physiotherapy. Trial of EUROLUPUS regimen (6 courses) of low dose cyclophosphamide <sup>[5]</sup>. Rivaroxaban for PE &amp; DVT. Inferior venae cavae filter for DVT. <h3>Outcome</h3> Regained full power, tone and reflexes of her lower limbs and walked without support after 6 courses of cyclophosphamide. however, she has residual left foot drop undergoing physiotherapy. Renal parameters marginally resolved. Pulmonary embolism and deep vein thrombosis resolved. <h3>Conclusion</h3> Lupus Vasculitis can affect any organ systems. Modalities for treatment are according to the presentation and severity of the disease. <h3>References</h3> [1]Lupus Vasculitis: An Overview [Internet]. [cited 2023 Jan 15]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8615745/ [2]Alarcón-Segovia D, Drenkard C. Vasculitis and the antiphospholipid syndrome [2]. Rheumatology. 2000;39(8):922–3. [3]Gorson KC. Vasculitic neuropathies: An update. Neurologist. 2007 Jan;13(1):12–9. [4]Gómez-Pacheco L, Villa AR, Drenkard C, Cabiedes J, Cabral AR, Alarcón-Segovia D. Serum anti-β2-glycoprotein-I and anticardiolipin antibodies during thrombosis in systemic lupus erythematosus patients. Am J Med. 1999 Apr;106(4):417–23. [5]Barile-Fabris L, Ariza-Andraca R, Olguín-Ortega L, Jara LJ, Fraga-Mouret A, Miranda-Limón JM, et al. Controlled clinical trial of IV cyclophosphamide versus IV methylprednisolone in severe neurological manifestations in systemic lupus erythematosus. Ann Rheum Dis. 2005 Apr;64(4):620–5. <h3>Acknowledgements</h3> to my prolific trainers- Prof.Adelowo an Dr Hakeem Olaosebikan. <h3>Disclosure of Interests</h3> Shalom ONWUALU ONOSENIGBUAN: None declared, Olisa Ochiagha: None declared, Olufemi Adelowo Grant/research support from: pfizer-Knowledge of rheumatoid arthritis amongst general practitioners in Nigeria, Hakeem Olaosebikan: None declared.